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This is VAERS ID 836556

Case Details

VAERS ID: 836556 (history)  
Form: Version 2.0  
Sex: Female  
Location: Foreign  
Submitted: 0000-00-00
Entered: 2019-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Death, Encephalopathy
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: CO0095075131909COL010578

Write-up: ENCEPHALOPATHY; This spontaneous report was received from a regulatory authority refers to a female patient of age 13 (units not reported). The patient''s pertinent medical history, concurrent conditions and concomitant medications were unknown. On an unknown date, the patient was vaccinated with quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (manufacturer unknown) 1200 milligrams (mg) (strength, route of administration, lot/batch # and expiration date were not reported) for prophylaxis. On an unknown date, the patient experienced encephalopathy. No diagnostic results were reported. The outcome of encephalopathy was reported as fatal. The patient died on an unknown date. The cause of death was not reported. It was unknown if autopsy was performed or not. Causality assessment between the suspect product and the event was not reported. ; Reported Cause(s) of Death: unknown

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